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WSIB and Insurance Documentation For Student Field Placements

The Insurance Guidelines for Coordinators of Student Placements (form #PW1553) is intended as a reference for schools involved in the coordination of work / education placement programs and is also available through the Publishing Centre as a package. 

The package comprises instructions for coordinators. The forms and letters that need to be sent to placement hosts are all shown below as separate documents, as referenced in the guideline. Many of these forms are available individually from the Publishing Centre and are indicated by form number as well. Word documents are provided for download and use by coordinators.

Student / Learner Placement Consent (Appendix A) (MS word doc)

Work/Education Placement Agreement (Appendix B) - form # PW1557

Sample Letter to Placement Host Covered by WSIB (Appendix C)  (MS word doc)

Letter of Authorization to Represent a Placement Host (Appendix D) (MS word doc)

Sample Letter to Placement Host Not Covered by WSIB (Appendix E) (MS word doc)

ACE INA Insurance Accident Report (Appendix F) - form # PW1555

ACE INA Insurance Personal Information Form #SGC102845 (Appendix G) - form # PW1556

The Employer Guideline provides instructions for placement hosts regarding the completion of forms.